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General NPI Number Information
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NPI Number | 1215392972
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Entity Type | Individual
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Provider Name | LACY M JENKINS CRNA
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Gender | Female
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Dates
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Enumeration Date | 12/23/2015
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Last Update Date | 12/23/2015
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Provider Practice Location Address
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Address Line | 1755 KIRBY PKWY SUITE 330
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City | MEMPHIS
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State | TN
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Zip | 38120-8300
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Country | US
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Telephone | 901-725-5846
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Fax | 901-726-4827
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Provider Business Mailing Address
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Address Line | DEPT 2607 PO BOX 11407
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City | BIRMINGHAM
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State | AL
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Zip | 35246-2607
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Country | US
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Telephone | 901-725-5846
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 20599
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License Number State | TN
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